Healthcare Provider Details

I. General information

NPI: 1710260153
Provider Name (Legal Business Name): JENNIFER LYNN KSAIBATI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 S FLORIDA AVE
LAKELAND FL
33813-2510
US

IV. Provider business mailing address

PO BOX 257
BRANDON FL
33509-0257
US

V. Phone/Fax

Practice location:
  • Phone: 877-389-2727
  • Fax:
Mailing address:
  • Phone: 877-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2769712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: